| Idahodhwbh Payettamhclinic | |
|
515 16th Ave N Payette ID 83661-2047 | |
| (208) 642-6416 | |
| (208) 642-2829 |
| Full Name | Idahodhwbh Payettamhclinic |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 515 16th Ave N, Payette, Idaho |
| Authorized Official Name and Position | Todd L Hurt (FIELD OPERATIONS MANAGER) |
| Authorized Official Contact | 2084557057 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Idahodhwbh Payettamhclinic 515 16th Ave N Payette ID 83661-2047 Ph: (208) 642-6416 | Idahodhwbh Payettamhclinic 515 16th Ave N Payette ID 83661-2047 Ph: (208) 642-6416 |
| NPI Number | 1558498097 |
|---|---|
| Provider Enumeration Date | 02/28/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558498097 | NPI | - | NPPES |
| 000010027633 | Other | ID | BLUESHIELD |
| HW298 | Other | ID | BLUE CROSS OF IDAHO |
| 8073592 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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